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Form JSA

This document is a Job Safety Analysis (JSA) for the activity of installing lights at PT. Javaro Abadi Sejahtera, dated October 31, 2022. It outlines required safety equipment, potential hazards, and basic job steps to mitigate risks associated with the work. The analysis emphasizes the importance of safety measures and precautions to ensure a safe working environment.

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abngikbal79
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18 views2 pages

Form JSA

This document is a Job Safety Analysis (JSA) for the activity of installing lights at PT. Javaro Abadi Sejahtera, dated October 31, 2022. It outlines required safety equipment, potential hazards, and basic job steps to mitigate risks associated with the work. The analysis emphasizes the importance of safety measures and precautions to ensure a safe working environment.

Uploaded by

abngikbal79
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Form No: JAS-HSE-JSA FORM Revision No: 01

JOB SAFETY ANALYSIS


PT. JAVARO ABADI SEJAHTERA

WORK ACTIVITY (JOB) TITLE: Memasang lampu DATE: 31 Oktober 2022


LOCATION : Warehouse JSA NO: jsa 01
WORK TEAM REVIEWED BY: JSA PREPARED BY:
1. Signature:
1. 7. 2. Signature:
2. 8. Name : si a 3. Signature:
3. 9. Signature:__________________ 4. Signature:
4. 10. 5. Signature:
5. 11. 6. Signature:
6. 12.
CRITICAL QUESTIONS: Everyone Ready/Capable To Work? ☐ Potential Spill/Gas Release Addressed? ☐ Worst Case Discussed? ☐

REQUIRED SAFETY EQUIPMENT

☐ Hard Hats ☐ Goggles ☐ Safety Harness ☐ Hearing Protection ☐ Barricades Other (List): To provide Hi – Viz vest when working close
☐ Safety Shoes ☐ Face Shield ☐ Cotton Gloves ☐ Flame Resistant Clothing ☐ LEL Monitor to the road________________________________
☐ Safety Glasses ☐ Work Vests ☐ Leather Gloves ☐ Fire Extinguisher ☐ H2S Monitor _____________________________________________
_____________________________________________
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS

☐ Hot Work Permit ☐ Special Pre-Job Safety Discussions ☐ Confined Space Entry Permit ☐ Pollution Prevention Measures
☐ Energy Isolation ☐ Review Emergency Action Plans ☐ Use of Specialized PPE ☐ Redundant Protection Measures
☐ Written Procedure ☒ Site/Job Orientation ☐ Overhead/Underground Utility Lines ☐ Simultaneous Operations
POTENTIAL HAZARDS
Form No: JAS-HSE-JSA FORM Revision No: 01
☐ Lifting Hazards ☐ Short Service Employees ☐ Elec. Shock/ Flash ☐ Dropped/Falling Objects ☐ Low Lighting ☐ Ionizing Radiation
☐ Fall Potential ☐ Water/Drowning Hazard (includes utility lines) ☐ Tripping/Slipping ☐ Breathing Hazard ☒ Other Ergonomic,
☐ Skin Irritants ☐ Mech. Equip. Hazards ☐ Haz. Chemical Exposure ☐ Excavation Hazard ☐ Environmental electrical from
☐ Confined Spaces ☐ Fire/Explosion Potential (includes H2S) ☐ Confined spaces Extremes electronic device
☐ Elev. Load/Work ☐ High Noise Levels ☐ Sharp Edges or Hot/Cold ☐ Elevated load or work ☐ Vehicle Operations
surfaces
☐ Pinch/Crush/Striking
Hazards
☐ Potential Release of
Energy

BASIC JOB STEPS POTENTIAL INCIDENTS OR WAYS TO ELIMINATE OR CONTROL HAZARDS PIC
HAZARDS
1. Persiapan alat kerja 1.1 Electrical Metode kerja
APD
1.2 Biological Metode Kerja
APD

2 Persiapan alat peraga 2.1 Electrical Metode kerja


2.2 Biological APD
2.3 Mechanical

3 Persiapan perangkat lunak aplikasi 3.1 Electrical Metode kerja


APD
4 Persiapan mental dan fisik peserta 4.1 Psikologi Metode Kerja
4.2 Physic Rekayasa suhu ruang kelas

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